A CASE OF CARDIAC MYELOID SARCOMA POST-ALLOGENEIC TRANSPLANTATION

Abstract

TYPE: Late Breaking Abstract TOPIC: Cardiovascular Disease INTRODUCTION: Extramedullary relapse of acute myelogenous leukemia (AML) has been reported in a small percentage of patients who received hematopoietic stem cell transplantation. Among the sites of involvement, cardiac myeloid sarcoma or cardiac chloroma is an exceedingly rare presentation. We present a case of a right atrial chloroma without medullary involvement in a patient with AML in remission. CASE PRESENTATION: A 53-year-old woman with a background of AML with myelodysplasia-related features status post-induction chemotherapy followed by an allogeneic hematopoietic stem cell transplant came to the emergency department with chest pain and shortness of breath. The patient was noted to have pericarditis and treatment was initiated. Transthoracic echocardiogram showed a right atrial mass extending into the pericardium, which was confirmed by cardiac magnetic resonance imaging (MRI). Initial right heart catheterization with tissue biopsy was indeterminate and a second one showed atypical cells with immunohistochemical stains consistent with myeloid sarcoma. Bone marrow biopsy did not show evidence of AML and treatment with Azacitidine and Venetoclax was indicated. DISCUSSION: The five-year survival rate for AML is 29.5% and the majority of patients die from infection or hemorrhage. The presence of cardio-respiratory symptoms in our patient led to an early diagnosis of cardiac myeloid sarcoma. It is a rare presentation that is usually diagnosed at autopsy with an incidence <1%. CONCLUSIONS: A high index of suspicion is a cornerstone in the early diagnosis and timely management of cardiac myeloid sarcoma. DISCLOSURE: No significant relationships. KEYWORD: chloroma